Provider Demographics
NPI:1912545765
Name:NATIONAL JEWISH WESTERN HEMOTOLOGY ONCOLOGY
Entity Type:Organization
Organization Name:NATIONAL JEWISH WESTERN HEMOTOLOGY ONCOLOGY
Other - Org Name:NATIONAL JEWISH WESTERN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:303-388-4461
Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2761
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-398-1211
Practice Address - Street 1:400 INDIANA ST STE 230
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-232-0602
Practice Address - Fax:303-988-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05201009Medicaid
CO1912545765Medicaid
CO9000180332Medicaid